HomeMy WebLinkAboutXC2023-0239 - Permit ApplicationPrint Form
Worksheet for Combo Building & Solar Permit Application
j Residential City of Newport Beach -Building Division)
NOTE: PLAN CHECK FEES DUE AT TIME OF St IRMITTAI
�--.
Comm'I
Building ❑Grading [,Drainage Elec Mech Plum C�vdCut�l CUYdFill�
I
Project Address (Not mailing address) ❑ Flood ❑ Fire F; Liq [ Landslide �N/A FloorSuite No
j7
Description of Work Use 7 onstT e
� 1�� YP i
--- # Stories # Units (if Res)[7)
Valuation $
New/Add SFRemodel SF Z I Garage/New/Add Material/Labor
OWNER'S NAME Last iIv / ''//
v1�NIi_C�7/-tp�� First
Owners Address Owner's E-mail Address
��
City — - � _ State ri�c I Zip Telephone
APPLICANT'S NAME Last L A_ Firs[ M ,(
---- - ----------
Applicant's Address Applicant's E-mail Address
MCI '1r�\_ A� 0-
--
City 0IfV State C .,_ Zip 'LT ( L Telephone 9 ZT75 Z,r yd
ARCHITECT/DESIGNER'S NAME Last 7 ) -i, _ --
�/�(-(f--_�_- --J First---jia;l, i Lic No. L- (�jG/,..S-�
Architect/Designer's Address Architect/Designer's E-mail Address
City State (G Zip
Telephone
-- — -- 1
ENGINEER'S NAME _ Lic. No.
Last F
rst � .
Engineer's Address Engineer's E-mail Address
City - - - State— Zip Telephone—'
CONTRACTOR'S NAME/COMPANY I o J3t_ p�7 �`,I)n by Lic No. J'Cl�l t Class n�
I f '[ r_
Contractor's Address Contractors E-mail Address
�14IY&10U _. Cf?� eiU 1--Clu 6.
n 1 A
city �� - _ State f'�-, Zip 1 i !� Telephone � �%il _ ( !6 I : _ I 1/) o
SETBACKS REAR SETBACKS FRONT - "'11 PERMIT NO. 2CCZOS3- CZZ3r 9
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. CU7_3 - I SEA
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $